My first Awful PT. any advice?

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Last Friday, one of the PTs I dealt with was a white, 52-year-old female, who was morbidly obease and bedridden. She was admitted for pneumonia. She actually came from a nursing home! I'm struggling to emotionally process my feelings of contempt for her, so please forgive me for sounding so incompassionate.

She was prescribed (among her laundry list of other drugs) 2mg of dilaudid q 4 hours. She was suddenly complaining of intense rectal pain that she said was cased by hemmorroids. She behaved so childishly- calling out "nurse!, nurse!, oh my backside! oohhh!!" she was already on her pain meds!!! she was about 45 minutes from being able to have more pain meds, but she was yelling at me to be a decent human being and do something for her. I siad I would tell her RN, which I did, and I explained to her that we wouldn't be able to give her anything more for 45 minutes. She was pounding her fist in her hand and saying "damnit! now you go do your job!, you dont even know how I feel!".

*sigh*. the RN called the Dr. He prescribed a cream for the hemorroids and we applied it as soon as It came up from the pharmacy. SHE HAD NO HEMORROIDS!!!.

So basically, I had a drugged slug-in-the-bed of a woman, who had essentially eaten herself so fat that she couldnt , or wouldn't get out of bed.She was so big we couldnt turn her becase there was no bed left to turn her in. oh and this was the icing on the cake- She also refused to use the bedpan, preferring instead to have Bowel movements on a chuks pad. How disgusting a human being can you be? I mean, my God, What 52 year old person lives in a nursing home?

I know I sound awful, but it truly what I was thinking in my head. I guess my question is, as a nurse, do i HAVE to feel compassion for ALL of my PTs? I just couldnt muster it up for this one, and I've been unable to stop thinking about it all weekend. Thanks for any advice.


1,446 Posts

Specializes in ED, ICU, PACU.

If it is any consolation for you, this woman must have had a mental illness to be in a NH at her age & to have been in the condition you describe.

Now, on the other hand, be thankful that you did not have to put a foley in her (have had my share of this type and every one needed a foley by moi)-yech! Hint for the future: if you get an order for a foley for this type of patient, go in through the rear----trust me, I have become an expert in this one thing ;)

I can sorta feel your frustration since I worked in nursing homes many moons ago. I'm not in the nursing program yet but I can bet that lady probably won't be the last annoying senseless patient you'll have to deal with. Hopefully you have a way to decompress after a day like that.... hope your next few patients are sweethearts. :)


66 Posts

Specializes in CNA, SPN, LPN.

I think that just the fact that it has bothered you all weekend shows you do have compassion for your patients. And even though you felt this way you provided care I am sure to the utmost of your abilities and would never compromise patient health and saftey. Just remember she is human just like the rest of us.:heartbeat


i would say no, you do not have feel all warm and fuzzy about all the patients you take care of. When I have patients like this I tend to take a lot more 5 minute breaks so I can take some deep breaths. the most important thing tho is the patient does not notice how upset you are getting. I work in an inpatient physical rehab so I get quite a few of these obese unmotivated lovelies. the best thing you can do is smile a lot and take plenty of deep

Specializes in Psychiatry.

When I've had assignments like the above pt you describe, I try my best to put things into perspective.

For instance, when I start feeling like I am getting low on the "compassion vitamin" I remind myself that I can WALK out of the hospital at the end of my shift and forget about it. My patients cannot.

Hope this helps. I've been there.



Specializes in Ortho, Neuro, Detox, Tele.

Age has nothing to do with why someone might be in a nursing home. and as stupid as it sounds, pain is what the pt says it is. I would have certainly assessed the rectal area first if thats what the pt says is hurting...had she not had a BM in a while, was it very hard, was it possible that she is just seeking meds....

I can leave at the end of my 12hrs...and my life is not as bad as my bad patients one. I hold them to a lower standard, because sometimes you just can't win. It is what it is...such is life.

Try hard to understand that pts will use whatever they can....and if it's 1am, i'm not calling for a cream....just use judgement and see what you can do.

morte, LPN, LVN

7,015 Posts

fyi, not all hemorrhoids are external.....

and no, you will not have the warm fuzzies for every single patient....just aint gonna happen

i'm having a problem with your post. you don't have to love your patients, i've had a few who were royal pains and this last week i heard some very colorful language directed at anyone and everyone. i've had a morbidly obese patient who six of us couldn't move, i was also in the room when the doctor came in and stated there just wasn't anything more he could do, that she needed to get things in order at 45.

the steroids she was on wasn't helping her weight she was hugely swollen as well as obese. no one enjoys cleaning up feces on a chux pad or having to dig it out of tissue folds. no one enjoys being screamed at by a patient, when there is nothing they can do. like it was said above, pain is what the patient says it is.

i was sent home to have my appendix rupture and walked around for almost week with it because the er really didn't believe my pain, i ended up septic, hospitalized for two weeks, because no one cared to believe me.

her rectal pain could be a sign of something quite severe, my father had severe rectal pain and ignored it for quite some time turned out he had cancer of his rectum.

UM Review RN, ASN, RN

1 Article; 5,163 Posts

Specializes in Utilization Management.

With a patient that I have trouble caring for, I basically turn off my emotions and just do what needs to be done.

For her, I'd have asked to order a bariatric bed if she was too large to be turned in the bed.

Certainly, I'd ask for a psych consult. I'd also try to get her to talk about other things besides her hemorrhoids; I've sometimes developed a rapport with a difficult even after they've physically / emotionally repulsed me beyond belief.

All the things that you describe point to the type of patient who is certainly in need of some compassion. After all, who'd want to live in a NH and be incontinent in a Chux?

--Also, come to think of it, I've worked in a few NH's in which the patients were encouraged to go into the Chux. The CNAs actually thought it was easier to clean up than to miss on a bedpan. This patient may have been "taught" to go that way.

Silverdragon102, BSN

1 Article; 39,477 Posts

Specializes in Medical and general practice now LTC.

No you do not have to like your patient but sometimes you need to think that there may be more going on than what you see. For some people being obese or even morbid obese isn't self inflicted, there could be other causes that got them to the state they are in and then you get stuck in a catch 22. Need exercise but can't exercise because obese. Be aware that you can come across these types of patients and they are not obese. I have seen my share from both thin patients to super obese and young to old and although you think they are a pain in the proverbial please try to give them the care they need


45 Posts

Kudos to you for posting your how you really felt!! Alot of people wouldn't have, there are alot of holier than thou people who don't like to admit these kinds of feeling...even though we all feel this way at times. And anybody that tells you they don't is lying!! You are only human!!

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